Healthcare Provider Details

I. General information

NPI: 1104859412
Provider Name (Legal Business Name): MONTGOMERY RADIOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E HIGH ST ATTN: RADIOLOGY DEPARTMENT
POTTSTOWN PA
19464-5008
US

IV. Provider business mailing address

27 REGENCY PLZ ATTN: REARDON GROUP
GLEN MILLS PA
19342-1001
US

V. Phone/Fax

Practice location:
  • Phone: 610-327-7282
  • Fax: 610-705-5675
Mailing address:
  • Phone: 610-459-9300
  • Fax: 610-459-5122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN SOLOMON
Title or Position: DIRECTOR
Credential: M.D.
Phone: 610-327-7282